ExpressReg PIN Request

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Express Reg Online Family PIN Request Form

Complete the form below and hit submit once. Be sure to include all family members residing in your home. Your Family PIN and Client ID Codes will be processed and forwarded to you via E-mail (please allow 48 hours for a response if an e-mail address is provided and you agree to e-mail communication). Otherwise, your Family PIN and Client ID Codes will be delivered by mail to the address provided below. Upon receipt, you will be able to register online via Express Reg.

Main Family Contact (must be 18 years of age)

Last Name: *

First Name: *

City:

Province:

Apt/Unit #:

Street #: *

Street Name: *

Postal Code: *

Home Phone Number: *

Work Phone Number:

Birth Date: *

(Mm/dd/yyyy)

Gender

Email:

Can we communicate via email (ie Family PIN #’s, receipts, program cancellation updates, registration reminders etc) and send a seasonal e-newsletter. *

Yes No

Additional Family Members (any other adult or child residing in your home).

Last Name	First Name	Birth Date	Gender	Work #
					Add Family Member

Personal information collected is pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of (a) creating a customer account, and (b) if this has been agreed to above by you, communicating via email and subscribing to a seasonal e-newsletter from Community, Culture and Recreation Services. Questions about this collection should be directed to the City Clerk's Division, City of Waterloo, 100 Regina Street South, Waterloo, ON, N2J 4A8.